Low IgA--anyone know anything about this?

st.augbride

I posted recently about ds constantly being sick. We now are on virus #3 in 3 weeks and he has had a >102 fever that won't leave him alone. Anyhow, I consulted with our developmental ped after the general ped proved useless (always says "it's just a virus/bad luck") and he suggested we see an immunologist. I then looked at all of our recent food allergy/celiac testing that the GI ran which she said was all normal, and I see that his total IgA levels were low relative to the reference range. I of course googled and see that people with lower IgA have a harder time mounting an immune response and get hit with everything. Amazing how not a single doctor mentioned this result to us despite all of ds's illnesses and issues. I'm just grateful to have our developmental ped (he emailed with me and requested to review the blood work; never would have caught this otherwise). I'm just so frustrated that nobody took me seriously before this and am now just wanting to see an immunologist asap. Anyone else know anything about this? TIA.

law&order

I just found this post by accident and don't ever post on this board, so I hope I'm not overstepping. I can tell you about our experience with low IgA and poor weight gain and borderline FTT.  My son has very low IgA and has seen a GI since he was 9 months old. Our GI did the celiac screen which she tells us is "inconclusive" because his IgA is so low. Celiac disease can be diagnosed via blood test and confirmed through endoscopy, but not if the IgA is below a certain level.  

Some kids are also just IgA deficient. This results in frequent illness, dental problems, poor weight gain. 

So a few thoughts- your son could have celiac disease, which could be diagnosed through endoscopy, but probably can't be diagnosed through the blood work they did. He could be IgA deficient...which some people just are.   According to my son's GI, there isn't really anything you can do to raise IgA (although my son's went up spontaneously over 1 year). 

I don't know if any of this helps, but hang in there.  We've struggled with very poor weight gain, low IgA, sensory/feeding issues, and anemia. Unfortunately I never feel like there is a good answer on some of this GI stuff. 

st.augbride

Wow, thanks for sharing. I'm sure you know exactly how taxing all the weight gain/FTT stuff is. Ds hasn't gained in 7 months from illnesses and nobody seems to care except for our developmental ped. Or at least nobody else had any insight and just sent us on our way. Ds also has some dental issues, major sensory issues, and definitely GI problems with reflux, chronic constipation (used to fluctuate between that and too loose), and possibly aspiration (undiagnosed as of yet but it's another thing I want to discuss).

So, when your LOs IgA went up after a year, is it still categorized as deficient or just lower? Ds's isn't at a level for deficiency, but is below reference range (his was 21, range 24-245), and given how wide that range is, I have to imagine that being lower than it makes him more prone to illness (which he clearly is given our experience). Have you received any other guidance on this? Does it affect your choice for childcare or social events?

Thanks for your help. Oh, and this bloodwork was taken during his adenoidectomy/upper endoscopy, so no signs of celiac there too.

law&order

st.augbride said:

Wow, thanks for sharing. I'm sure you know exactly how taxing all the weight gain/FTT stuff is. Ds hasn't gained in 7 months from illnesses and nobody seems to care except for our developmental ped. Or at least nobody else had any insight and just sent us on our way. 

I think growth at this age is hard because we are dealing with small kids and potential nutrition issues, but we're also dealing with picky (and sometimes extremely picky) toddlers. We also see a pediatric dietician. My son didn't have any gain from April-July and while we had hoped he'd gain, he did grow in height and so she was not concerned. 

Ds also has some dental issues, major sensory issues, and definitely GI problems with reflux, chronic constipation (used to fluctuate between that and too loose), and possibly aspiration (undiagnosed as of yet but it's another thing I want to discuss).

Seems like he has a lot of feeding-related issues. I might seek a secondary GI opinion and probably see a dietician to help manage this.  Is he in OT for sensory things? We did 6 weeks of OT for feeding at 13-14 months. 

So, when your LOs IgA went up after a year, is it still categorized as deficient or just lower? Ds's isn't at a level for deficiency, but is below reference range (his was 21, range 24-245), and given how wide that range is, I have to imagine that being lower than it makes him more prone to illness (which he clearly is given our experience). Have you received any other guidance on this? Does it affect your choice for childcare or social events?

He was 11 or 12 at his lowest and it went up to about 22 I think. I can't find it though.  The GI and dietician just continue to say he is "very low." My son has been cared for by family for the last two years and they've been great about following his OT needs and diet needs. He's also been very healthy because he hasn't been in a daycare setting.  He starts preschool in two weeks though and I'm anticipating that this is when we may see the low IgA/frequent illness problems.  It's hard to know since kids in preschool are, like, ALWAYS sick. I will say that my son does tend to be "fever" kid more than most.  Any time he gets a cold he always gets a fever of 102-103 when other kids will just get the cold symptoms.  

Thanks for your help. Oh, and this bloodwork was taken during his adenoidectomy/upper endoscopy, so no signs of celiac there too.

It's good that he's not celiac, but I'm sure it's frustrating too. Sort of like, well why is he low IgA then?!  We are thisclose to doing the exploratory endoscopy just to see if our son is celiac, even though it's a really hard thing to diagnose in young kids. 

In your case, I might seek assistance from a dietician and a second GI opinion.  I find it weird that none of his doctors care about his lack of weight gain and his low IgA.  Our pedi, GI, and dietician are all concerned enough in my son's case and he has outgrown his sensory issues, and doesn't have the additional GI problems your son does.  

st.augbride

Yeah, ds has grown in height too, thankfully. He was <1st for weight and height at birth due to growth restriction from a bad placenta, so we've been at this for a while. However, the constant illnesses only got bad since he was 2 yrs old. He was on BM until 14 months and then didn't walk until almost 17 months, and by then it was nearly summer and he wasn't walking really well for a while after that. Now of course he's everywhere and into everything. It was pretty striking though that he started getting sick almost immediately after he stopped getting BM. I am actually BFing dd now, so I think I might try spiking his pediasure with some BM to see if it helps given all the immunologic properties in it, including IgA. Dd definitely does not get as sick as ds when she catches the same things.

We've seen a nutritionist and it didn't help since they only suggested he eat x, y and z, which if we could get him to eat then we wouldn't be seeing one! I do wonder if he has any deficiencies. We're doing a feeding eval in a month at Kennedy Krieger, so I will ask about that and there will be another GI there too to look at everything (which will be the 4th GI we've worked with...).

Ds's feeding issues are the main problem, but the constant illnesses don't help! He was in a home daycare and then switched to a preschool in June. It's a great environment for him as he's a very social little guy and super bright, so I want him to be there. But it is SUCH a germ factory!

realisticdreams

Hey, sorry I didn't read all the other replies because I have a killer headache, but M (dd2) had low IGG/IGA.  She was a late-term preemie & had IUGR as well.  We saw Gi and had upper endo done which showed no signs of EE, she always had a lot of fevers/viruses/etc.  Her dx related to her low levels is the congential/transient hypogammaglobulinemia.  We had titers done as well and none of her vaccines had really "taken"
She is finally on the growth chart at 23lbs at 2 1/2

st.augbride

realisticdreams said:

Hey, sorry I didn't read all the other replies because I have a killer headache, but M (dd2) had low IGG/IGA.  She was a late-term preemie & had IUGR as well.  We saw Gi and had upper endo done which showed no signs of EE, she always had a lot of fevers/viruses/etc.  Her dx related to her low levels is the congential/transient hypogammaglobulinemia.  We had titers done as well and none of her vaccines had really "taken"
She is finally on the growth chart at 23lbs at 2 1/2

Thanks so much for sharing. So, by transient, do you mean that it's since resolved? Any improvements with the fevers, etc? How does she eat now?

realisticdreams

Yes, her last levels were within normal range, she ended up being diagnosed with PFAPA for all the fevers, once she started her kidney meds the fevers mostly disappeared, although she had one this past weekend with elevated CRP & SED rate so who the H knows anymore!